Black, Hispanic and Asian patients in Oregon receive worse medical care from emergency responders than white patients, according to a new study that has the endorsement of state health officials.
The first-of-its-kind look at how paramedics and ambulance services treat people for pain-related emergencies shows that complaints of pain from black, Asian and Latino people are sometimes ignored or receive fewer painkillers. Emergency crews are often the first point of contact with the medical system, but the racial biases of responders have not been examined before.
“This study provides evidence that the inequity of the medical care they receive starts at the beginning of their interaction with health care when they call 911 for EMS treatment,” said David Lehrfeld, medical director of Oregon Health Authority’s Emergency Medical Services & Trauma Systems.
The Oregon Health Authority and federal health agencies financially supported the study.
The study was conducted by Jamie Kennel, a professor for the emergency medical services and paramedic education programs offered at the Oregon Institute of Technology in Portland and Oregon Health & Science University.
Kennel looked at 104,000 medical charts for people who received emergency medical services between 2015 and 2017. Pain management is one of the few ways to retroactively look at how biases — subconscious or not — play out in the medical field. Likely, these problems manifest in various other ways people of color receive care, Kennel said.
Stereotypes, prejudices and other factors can play out in the few seconds it takes to determine how to treat someone. If those factors can be identified and shown to be harmful to the patients served, then perhaps emergency crews will be able to better serve all Oregonians, Kennel said.
Kennel found a pattern of treating pain of black, Hispanic and Asian patients with less seriousness than that of white patients.
Black patients were 40 percent less likely to be given pain medication than white patients in Oregon. Asian patients were 36 percent less likely.
Lehrfeld said that first responders interact with poor and uninsured people more often than many other types of medicine. The fact that those groups, who are disproportionately people of color, receive lowerquality care means there is a fundamental flaw in the health care system.
The study found that the disparity in care jumps significantly for people on private insurance. Black people with private insurance were 56 percent less likely to receive pain medication than white people.
Kennel said that indicates that socioeconomic factors can’t account for the unequal treatment. Many people try to chalk up differences in care to differences in income or say that people on government-subsidized insurance receive worse care across the board. But people who are on private insurance largely are more middle class, no matter their race.
“This study is saying, ‘Nope.’ We’ve controlled for that. It’s not about being about poor, it’s in fact about being African American,” Kennel said.
Oregon has broad regulations in the kind of treatments emergency medical providers are allowed to offer. In some states, such as California, paramedics must call a nurse to sign off on a procedure. But in Oregon, paramedics have more latitude to make those decisions for themselves.
While that can be beneficial in dire situations, it also means that there are more ways for first responders to succumb to prejudices.
Kennel pointed to the example of how different cultures might display pain. If a paramedic expects someone who says their pain is an eight out of 10 to be crying or wincing, but the patient is stoic, the paramedic might mark down that the pain is actually a two.
“If I’m not of the same upbringing or race or culture as the patient, I may misinterpret that response,” Kennel said.
His findings have already been embraced by American Medical Response, Multnomah and Clackamas counties’ ambulance contractor.
Robert McDonald, operations manager at American Medical Response, said the company volunteered its records for the study. Multnomah County emphasized equity when it renewed its contract with one of the nation’s largest ambulance service providers. In Portland, local officials had started to collect data already to evaluate disparities in its service.
McDonald said that American Medical has begun to confront the issue on two fronts — first, they have stepped up recruitment from diverse communities around Oregon. They hope that more people of color, immigrants, women and other demographics underrepresented in their current workforce will help improve the quality of care.
The second is training. McDonald said the company hopes by the end of 2019 to have trainings that teach emergency crews how to recognize their own biases so that those don’t get in the way of offering the best medical care possible.
Checklists that require pain assessments for every patient a crew picks up could be one measure. The study found that white and black patients receive pain assessments 40 percent of the time. That drops to 37 percent for Hispanic patients and 34 percent for Asian patients.
But an objective measure like a checklist could ensure equal treatment through protocol.
“In the end, I’m really kind of excited by it. I think EMS in the nation is looking at us, because this is really something brand new,” McDonald said.
— Molly Harbarger